The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

The October jobs report from the Bureau of Labor Statistics showed unemployment inching up from 7.2 percent in the September report to 7.3 percent today. That, however, wasn’t the most significant concern emerging from those numbers.

The healthcare industry added about 15,000 jobs in October, slightly lower than 17,000 jobs-per-month average we’ve seen so far this year and significantly below the average monthly increase of 27,000 in 2012.

Yes, healthcare is still proving to be a vital job-creating engine for our nation’s economy, but the concern at hand is whether job growth in the various health professions will keep pace with escalating demands caused by Affordable Care Act health exchange enrollments, Medicaid expansion and the aging of the U.S. population.

There has been a great deal written about our society’s increasing need for doctors as health services utilization stays on an upward trend, but it’s not just physicians. The current and potential healthcare workforce shortages extend to all parts of the workforce, from nurses to pharmacists to researchers.

The multi-sector membership of the Healthcare Leadership Council is actively engaged on this issue.

During meetings with members of Congress and congressional candidates, HLC has consistently emphasized workforce shortages and the corresponding need for more interest and participation in science, technology, engineering and math (STEM) education; realignment of incentives to encourage more integrated, coordinated team care; and adequate payments for hospitals, clinics, doctors, laboratories and other providers.

This month, we will be bringing together representatives from our member companies and organizations for in-depth discussions on how multiple sectors can bring their particular insights to this challenge and to focus on the public policy steps that could help alleviate the healthcare workforce shortages – shortages that are likely to be exacerbated in the very immediate future.

There are numerous concerns these days about the nation’s supply of medical professionals to meet America’s growing elderly population as well as the millions of citizens who will gain health coverage when the Affordable Care Act is fully implemented. How will the healthcare workforce meet this rising patient demand?

We received good news this week regarding the supply of nurses. A RAND study shows that the number of young nurses – registered nurses between the ages of 23 and 26 – has grown by 62 percent between 2002 and 2009. This reverses a course projected back in 2000 by a study in the Journal of the American Medical Association, which said the U.S. would have a 20 percent shortfall in the supply of nurses by 2020.

Dr. Peter Buerhaus of the Vanderbilt School of Nursing (Colleen Conway-Welch, the nursing school’s dean, is a Healthcare Leadership Council member) was one of the authors of the earlier JAMA study and told Nashville Public Radio that he’s no longer worried about a nursing shortage. He credited more colleges adding nursing programs and successful initiatives raising awareness about personnel shortages and job openings in the nursing field.

As a study published in Health Affairs this week points out, anyone who believes they have a handle on what will happen when Medicaid undergoes an unprecedented expansion this decade is kidding themselves.

The study by a trio of professors at Harvard University’s School of Public Health shows a huge possible variation in the number of low-income Americans who enroll in Medicaid once eligibility is expanded in 2014 to include anyone below 138 percent of the federal poverty level. The expansion, according to the researchers, could be as low as 8.5 million individuals or as high as 22.4 million, with a range of possible federal spending increases from $34 billion to $98 billion annually.

What I find particularly interesting about this study, though, is the projected impact on healthcare utilization. Because Medicaid has lower cost-sharing than private insurance, there is an expected increase in the demand for health services among those who move from private plans to Medicaid once eligibility levels change. Between the larger Medicaid population and this increased utilization, the Harvard researchers say the U.S. will need anywhere from 4,500 to 12,100 additional physicians to care for new Medicaid patients.

Here’s a critical passage in the report:

“These changes may pose major challenges in healthcare access because in recent years an increasing number of physicians have stopped accepting Medicaid patients. The Affordable Care Act does provide enhanced Medicaid reimbursement to primary care clinicians for 2013-2014, but this may not be enough to ensure an adequate supply of providers for new Medicaid patients.”

Some of us have continued to argue that coverage does not necessarily mean access. It is, without question, vitally important to provide coverage for the nation’s uninsured population, but it’s still an open question as to whether Medicaid expansion is the most effective tool for doing so.

Those non-financial reasons included not being able to get to a doctor’s office during working hours, long commutes to the medical office, or not being able to get an appointment soon enough. As the study’s lead author said, “In reality, there are all kinds of reasons why people can’t get the care they need when they need it.”

There are at least a couple of important points to take from this report. One is that healthcare providers have to continue exploring creative ways, from telemedicine to non-traditional office hours, to meet the needs of today’s patient population.

More importantly, though, as we’ve said often over the past several months, coverage and access are not synonymous with each other. The Affordable Care Act makes health coverage available to all Americans, but that doesn’t mean that all of these newly-insured patients will have easy access to quality care. If some patients today, as the study indicates, have difficulty getting an immediate appointment with a physician, that problem may only worsen when an influx of new patients, the aging of the baby boom generation and a future shortage of healthcare professionals converge.

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In a post in this column last week, we mentioned that Texas Governor Rick Perry’s candidacy for the presidency may help ignite a national debate over medical liability reform, since Texas has adopted one of the most effective tort reform measures in the country.

It didn’t take long for those battle lines to be drawn. Politico is reporting today that the nation’s trial attorneys are ready to dig deeply into their pockets to make sure Perry is defeated.

The Republican presidential candidates who participated in last night’s Iowa debate put on quite an interesting, as well as entertaining, show. With political analysts pointing out that this weekend’s Ames straw poll could winnow the field, the gloves came off as the eight candidates fought to maintain a critical mass of voter support.

Anyone who turned on the debate, though, to learn the candidates’ visions for healthcare in the United States would have come away disappointed.

We learned, to no one’s surprise, that the GOP presidential contenders have a steadfast dislike for the Affordable Care Act that President Obama signed into law last year. Most of the candidates also believe that the individual health insurance mandate contained in the ACA is unconstitutional.

It was also clear that, as long as former Massachusetts Governor Mitt Romney is the frontrunner, he will be criticized for what rival Tim Pawlenty calls “Obamneycare.”

But future GOP debates need to do more than reaffirm what the White House aspirants are against. There are indeed widespread concerns about the current health reform law, including questions over affordability, healthcare quality and whether an unprecedented expansion of Medicaid is the best approach for reducing the uninsured population. Those who would take Mr. Obama’s place need to spell out for us how they would do things differently. The questions they need to answer include:

• Do you support eliminating pre-existing conditions as a barrier to health coverage? And, if so, how do you achieve that without an individual mandate to ensure that consumers don’t wait until they’re sick or injured to purchase health insurance?

• How do you slow down the growth in healthcare costs without undermine healthcare quality, access or innovation?

• How do you address the question of Medicare sustainability?

• What are your answers to the projected workforce shortages in healthcare? How do we ensure enough medical professionals to treat a growing patient population?

• With the CDC calling for a huge escalation in the number of Americans with diabetes, how do you propose to address the rise in chronic disease cases that are driving healthcare costs?

With these questions and many others, there’s an important health policy debate to be had among the Republican presidential contenders. It just hasn’t happened yet.